2025-34年国际卫生援助支助的方案中断可能造成的儿科结核病发病率和死亡：一项数学建模研究。

IF 15.5 1区医学 Q1 PEDIATRICS

Lancet Child & Adolescent Health Pub Date : 2025-09-12 DOI:10.1016/S2352-4642(25)00218-4

Nicolas A Menzies PhD , Tyler S Brown MD , Jeffrey W Imai-Eaton PhD , Prof Peter J Dodd PhD , Prof Ted Cohen MD DrPH , Leonardo Martinez PhD

{"title":"2025-34年国际卫生援助支助的方案中断可能造成的儿科结核病发病率和死亡：一项数学建模研究。","authors":"Nicolas A Menzies PhD , Tyler S Brown MD , Jeffrey W Imai-Eaton PhD , Prof Peter J Dodd PhD , Prof Ted Cohen MD DrPH , Leonardo Martinez PhD","doi":"10.1016/S2352-4642(25)00218-4","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Children are at increased risk of developing and dying from tuberculosis. We aimed to estimate the additional paediatric tuberculosis deaths that could occur over 2025–34 if programmes supported by US bilateral health aid and The Global Fund to Fight AIDS, Tuberculosis, and Malaria are discontinued.</div></div><div><h3>Methods</h3><div>For this modelling study we collated data on funding sources for tuberculosis and HIV programmes in low-income and middle-income countries and constructed scenarios representing reductions in health aid from 2025. Using calibrated transmission-dynamic models of tuberculosis and HIV for 130 countries, we projected the discontinuation of tuberculosis and HIV treatment services under several funding reduction scenarios, and how this would affect paediatric (ages 0–14 years) tuberculosis exposure and treatment access. We projected paediatric tuberculosis incidence and mortality over 2025–34 to calculate the impact of funding reductions.</div></div><div><h3>Findings</h3><div>Compared to maintenance of pre-2025 service levels, withdrawal of services currently supported by US bilateral health aid is projected to result in an additional 2·5 million (95% uncertainty interval [UI] 1·8–3·3) paediatric tuberculosis cases and 340 000 (240 000–460 000) tuberculosis deaths over 2025–34. Withdrawal of US support to The Global Fund and reductions in non-US contributions are projected to result in an additional 8·9 million (95% UI 6·9–11·5) paediatric tuberculosis cases and 1·5 million (1·1–2·0) tuberculosis deaths, more than double the number of paediatric tuberculosis deaths expected with continued service levels (1·10 million [0·89–1·38]). Impacts were greatest in the WHO African and South-East Asia regions. Restoration of services in 2026 was projected to lead to a substantially smaller number of additional deaths (39 000 [95% UI 29 000–51 000]).</div></div><div><h3>Interpretation</h3><div>Without actions to restore discontinued services, cuts to health aid for tuberculosis and HIV programmes could result in millions of additional childhood tuberculosis cases and deaths in low-income and middle-income countries over the next decade.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 11","pages":"Pages 787-795"},"PeriodicalIF":15.5000,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Potential paediatric tuberculosis incidence and deaths resulting from interruption in programmes supported by international health aid, 2025–34: a mathematical modelling study\",\"authors\":\"Nicolas A Menzies PhD , Tyler S Brown MD , Jeffrey W Imai-Eaton PhD , Prof Peter J Dodd PhD , Prof Ted Cohen MD DrPH , Leonardo Martinez PhD\",\"doi\":\"10.1016/S2352-4642(25)00218-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Children are at increased risk of developing and dying from tuberculosis. We aimed to estimate the additional paediatric tuberculosis deaths that could occur over 2025–34 if programmes supported by US bilateral health aid and The Global Fund to Fight AIDS, Tuberculosis, and Malaria are discontinued.</div></div><div><h3>Methods</h3><div>For this modelling study we collated data on funding sources for tuberculosis and HIV programmes in low-income and middle-income countries and constructed scenarios representing reductions in health aid from 2025. Using calibrated transmission-dynamic models of tuberculosis and HIV for 130 countries, we projected the discontinuation of tuberculosis and HIV treatment services under several funding reduction scenarios, and how this would affect paediatric (ages 0–14 years) tuberculosis exposure and treatment access. We projected paediatric tuberculosis incidence and mortality over 2025–34 to calculate the impact of funding reductions.</div></div><div><h3>Findings</h3><div>Compared to maintenance of pre-2025 service levels, withdrawal of services currently supported by US bilateral health aid is projected to result in an additional 2·5 million (95% uncertainty interval [UI] 1·8–3·3) paediatric tuberculosis cases and 340 000 (240 000–460 000) tuberculosis deaths over 2025–34. Withdrawal of US support to The Global Fund and reductions in non-US contributions are projected to result in an additional 8·9 million (95% UI 6·9–11·5) paediatric tuberculosis cases and 1·5 million (1·1–2·0) tuberculosis deaths, more than double the number of paediatric tuberculosis deaths expected with continued service levels (1·10 million [0·89–1·38]). Impacts were greatest in the WHO African and South-East Asia regions. Restoration of services in 2026 was projected to lead to a substantially smaller number of additional deaths (39 000 [95% UI 29 000–51 000]).</div></div><div><h3>Interpretation</h3><div>Without actions to restore discontinued services, cuts to health aid for tuberculosis and HIV programmes could result in millions of additional childhood tuberculosis cases and deaths in low-income and middle-income countries over the next decade.</div></div><div><h3>Funding</h3><div>None.</div></div>\",\"PeriodicalId\":54238,\"journal\":{\"name\":\"Lancet Child & Adolescent Health\",\"volume\":\"9 11\",\"pages\":\"Pages 787-795\"},\"PeriodicalIF\":15.5000,\"publicationDate\":\"2025-09-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lancet Child & Adolescent Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2352464225002184\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Child & Adolescent Health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352464225002184","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}

引用次数: 0

摘要

背景：儿童患结核病和死于结核病的风险增加。我们的目的是估计如果美国双边卫生援助和全球抗击艾滋病、结核病和疟疾基金支持的项目停止，2025-34年期间可能发生的额外儿科结核病死亡人数。方法：在这项建模研究中，我们整理了低收入和中等收入国家结核病和艾滋病毒项目的资金来源数据，并构建了代表2025年起卫生援助减少的情景。通过对130个国家的结核病和艾滋病毒的校准传播动态模型，我们预测了几种资金减少情景下结核病和艾滋病毒治疗服务的中断，以及这将如何影响儿童（0-14岁）结核病暴露和治疗可及性。我们预测了2025-34年的儿科结核病发病率和死亡率，以计算资金减少的影响。研究结果：与维持2025年前的服务水平相比，目前由美国双边卫生援助支持的服务的退出预计将导致2025-34年间额外的250万（95%不确定区间[UI] 1.8 - 3.3）儿科结核病病例和34万（24万-46万）结核病死亡。美国撤回对全球基金的支持和减少非美国捐款预计将导致额外的890万（95% UI为6.9 - 11.5）例儿科结核病病例和150万（1.1 -2）例结核病死亡，这是在保持服务水平的情况下预计的儿科结核病死亡人数（1.1万[0.89 - 1.38]）的两倍多。世卫组织非洲和东南亚区域受到的影响最大。预计2026年恢复服务导致的额外死亡人数将大大减少（39 000人[95%死亡率29 000-51 000人]）。解释：如果不采取行动恢复中断的服务，削减结核病和艾滋病毒方案的保健援助可能导致今后十年中低收入和中等收入国家新增数百万儿童结核病病例和死亡。资金:没有。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Potential paediatric tuberculosis incidence and deaths resulting from interruption in programmes supported by international health aid, 2025–34: a mathematical modelling study

Background

Children are at increased risk of developing and dying from tuberculosis. We aimed to estimate the additional paediatric tuberculosis deaths that could occur over 2025–34 if programmes supported by US bilateral health aid and The Global Fund to Fight AIDS, Tuberculosis, and Malaria are discontinued.

Methods

For this modelling study we collated data on funding sources for tuberculosis and HIV programmes in low-income and middle-income countries and constructed scenarios representing reductions in health aid from 2025. Using calibrated transmission-dynamic models of tuberculosis and HIV for 130 countries, we projected the discontinuation of tuberculosis and HIV treatment services under several funding reduction scenarios, and how this would affect paediatric (ages 0–14 years) tuberculosis exposure and treatment access. We projected paediatric tuberculosis incidence and mortality over 2025–34 to calculate the impact of funding reductions.

Findings

Compared to maintenance of pre-2025 service levels, withdrawal of services currently supported by US bilateral health aid is projected to result in an additional 2·5 million (95% uncertainty interval [UI] 1·8–3·3) paediatric tuberculosis cases and 340 000 (240 000–460 000) tuberculosis deaths over 2025–34. Withdrawal of US support to The Global Fund and reductions in non-US contributions are projected to result in an additional 8·9 million (95% UI 6·9–11·5) paediatric tuberculosis cases and 1·5 million (1·1–2·0) tuberculosis deaths, more than double the number of paediatric tuberculosis deaths expected with continued service levels (1·10 million [0·89–1·38]). Impacts were greatest in the WHO African and South-East Asia regions. Restoration of services in 2026 was projected to lead to a substantially smaller number of additional deaths (39 000 [95% UI 29 000–51 000]).

Interpretation

Without actions to restore discontinued services, cuts to health aid for tuberculosis and HIV programmes could result in millions of additional childhood tuberculosis cases and deaths in low-income and middle-income countries over the next decade.

Funding

None.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Lancet Child & Adolescent Health Psychology-Developmental and Educational Psychology

CiteScore

40.90

自引率

0.80%

发文量

381

期刊介绍： The Lancet Child & Adolescent Health, an independent journal with a global perspective and strong clinical focus, presents influential original research, authoritative reviews, and insightful opinion pieces to promote the health of children from fetal development through young adulthood. This journal invite submissions that will directly impact clinical practice or child health across the disciplines of general paediatrics, adolescent medicine, or child development, and across all paediatric subspecialties including (but not limited to) allergy and immunology, cardiology, critical care, endocrinology, fetal and neonatal medicine, gastroenterology, haematology, hepatology and nutrition, infectious diseases, neurology, oncology, psychiatry, respiratory medicine, and surgery. Content includes articles, reviews, viewpoints, clinical pictures, comments, and correspondence, along with series and commissions aimed at driving positive change in clinical practice and health policy in child and adolescent health.